Abstract P431: White-Matter Disease Burden and Cerebral Microbleeds After Extracorporeal Membrane Oxygenation Support

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Karan Topiwala ◽  
Tapan Mehta ◽  
Huseyin Tore ◽  
Bharati Jagadeesan
Keyword(s):  
White Matter ◽  
Extracorporeal Membrane Oxygenation ◽  
Median Duration ◽  
Disease Burden ◽  
Cerebral Microbleeds ◽  
Ecmo Support ◽  
Cerebral White Matter ◽  
White Matter Disease ◽  
Membrane Oxygenation

Introduction: Cerebral microbleeds (CMBs) have been increasingly reported in patients receiving extracorporeal membrane oxygenation (ECMO) support. Both, CMBs and cerebral white-matter disease (WMD) are thought to be a result of microvascular lipo-hyalinosis; as commonly seen in an aging brain. The pathogenesis of microbleeds after ECMO, has not yet been definitively established. We sought to examine the relationship between cerebral WMD burden and microbleeds after ECMO-support at a single tertiary referral academic hospital with high volumes of ECMO patients. Methods: All patients receiving venovenous (vv) and venoarterial (va) ECMO between January 2013 to January 2018 were retrospectively examined. The distribution of white matter hyperintensities was quantified using the Walhund age-related white matter changes (ARWMC) scale and correlated with the presence of cerebral microbleeds on brain MRI studies with Susceptibility Weighted Imaging (SWI) performed shortly after cessation of ECMO. Results: A total of 307 ECMO patients were reviewed, among whom 44 patients (vv:va= 13:31; male:female= 29:15) received at-least one MRI-brain study with SWI sequences after ECMO decannulation. The median duration of ECMO support was 4 days (range 1-25 days), with median duration from decannulation-to-MRI being 11.5 days (range 3-724 days). Microbleeds were present in 77.3% (n=34) patients, with 38.2% (n=13), 14.7% (n=5), and 47.1% (n=16) having mild (<10), moderate (10-30) and severe (>30) CMBs respectively. The median Walhund ARWMC score was 1 (range 0-22). Age and sex adjusted Walhund scores were not found predictive of CMB presence (p=0.578 [0.90-1.19]). Of 44 patients with at-least one post-ECMO MRI, 10 patients had a follow-up MRI scan at a median duration of 4 months (range 0.22-55 months); all of whom had unchanged CMB burden. At 10-month median clinical follow-up (range 0-76 months), none of the 34 patients with CMBs on initial MRI-study had presented with an intracranial hemorrhage. Conclusion: Development of CMBs after ECMO support is independent of microvascular lipo-hyalinosis, as estimated from cerebral white-matter disease burden. This requires further study in a larger sample-size.

scholarly journals Follow-Up Study of Adolescents Exposed to Di(2-Ethylhexyl) Phthalate (DEHP) as Neonates on Extracorporeal Membrane Oxygenation (ECMO) Support

2004 ◽  
Vol 112 (13) ◽  
pp. 1339-1340 ◽  
Author(s):  
Khodayar Rais-Bahrami ◽  
Susan Nunez ◽  
Mary E. Revenis ◽  
Naomi L.C. Luban ◽  
Billie L. Short
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Ecmo Support ◽  
Follow Up Study ◽  
Membrane Oxygenation ◽  
Ethylhexyl Phthalate

scholarly journals Extracorporeal Membrane Oxygenation for SARS-CoV-2 Acute Respiratory Distress Syndrome: A Retrospective Study From Hubei, China

2021 ◽  
Vol 7 ◽  
Author(s):  
Xiaobo Yang ◽  
Ming Hu ◽  
Yuan Yu ◽  
Xijing Zhang ◽  
Minghao Fang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Median Duration ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Arterial Blood ◽  
Before And After

Background: The data on long-term outcomes of patients infected by SARS-CoV-2 and treated with extracorporeal membrane oxygenation (ECMO) in China are merely available.Methods: A retrospective study included 73 patients infected by SARS-CoV-2 and treated with ECMO in 21 intensive care units in Hubei, China. Data on demographic information, clinical features, laboratory tests, ECMO durations, complications, and living status were collected.Results: The 73 ECMO-treated patients had a median age of 62 (range 33–78) years and 42 (63.6%) were males. Before ECMO initiation, patients had severe respiratory failure on mechanical ventilation with a median PO2/FiO2 of 71.9 [interquartile range (IQR), 58.6–87.0] mmHg and a median PCO2 of 62 [IQR, 43–84] mmHg on arterial blood analyses. The median duration from symptom onset to invasive mechanical ventilation, and to ECMO initiation was19 [IQR, 15–25] days, and 23 [IQR, 19–31] days. Before and after ECMO initiation, the proportions of patients receiving prone position ventilation were 58.9 and 69.9%, respectively. The median duration of ECMO support was 18.5 [IQR 12–30] days. During the treatments with ECMO, major hemorrhages occurred in 31 (42.5%) patients, and oxygenators were replaced in 21 (28.8%) patients. Since ECMO initiation, the 30-day mortality and 60-day mortality were 63.0 and 80.8%, respectively.Conclusions: In Hubei, China, the ECMO-treated patients infected by SARS-CoV-2 were of a broad age range and with severe hypoxemia. The durations of ECMO support, accompanied with increased complications, were relatively long. The long-term mortality in these patients was considerably high.

scholarly journals Clinical outcomes of postoperative extracorporeal membrane oxygenation support in Stanford type a aortic dissection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fudong Fan ◽  
Qing Zhou ◽  
Jun Pan ◽  
Hailong Cao ◽  
Kai Li ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Outcomes ◽  
Type A ◽  
Ecmo Support ◽  
Type A Aortic Dissection ◽  
Membrane Oxygenation ◽  
Va Ecmo ◽  
Support Time

Abstract Background Extracorporeal membrane oxygenation (ECMO) support may be considered to reduce mortality but survival and clinical outcomes are uncertain after Stanford type A Aortic dissection (TAAD). We analyzed the data of TAAD patients with postoperative ECMO support in our institution to investigate clinical outcomes. Methods In this retrospective cohort study, all clinical data of TAAD patients with postoperative ECMO support from January 2013 to October 2019 in our institution were harvested. Cases with redo or incomplete records were excluded. Results 22 cases were enrolled, 18 male and 4 female. The mean age was52.85±10.91 years. 20 patients underwent VA-ECMO treatment and 2 patients received VV-ECMO support. The support time was92.54±78.71 hours. 9 patients were successfully weaned from ECMO. 30-day in-hospital survival rate was 27.27 % (6/22). The follow-up duration is from 5 to 74 months. The median follow-up time is 35 months. Only four patients were still alive at the end of the follow-up period. Conclusions The mortality of TAAD patients with postoperativesevere circulatory and respiratory dysfunctions is high. ECMO would be considered as a valuable contribution to save lives. But more experience needs to be accumulated to improve clinical outcome.

scholarly journals Anticoagulation after VA-ECMO decannulation, providing new insights

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Maestro-Benedicto ◽  
A Duran-Cambra ◽  
M Vila-Perales ◽  
J Sans-Rosello ◽  
J Carreras-Mora ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Anticoagulation Therapy ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Funding Sources ◽  
Va Ecmo ◽  
A Prospective Study

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an essential tool for the management of refractory cardiogenic shock. Little is known about the incidence of thromboembolic events after V-A ECMO decannulation, although some studies report a high incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation (VV-ECMO). Due to this fact, in our institution anticoagulation therapy is systematically prescribed for at least 3 months after VA-ECMO per protocol.  AIM The main objective of this study was to explore the feasibility of 3-month anticoagulation therapy after VA-ECMO decannulation. METHODS We performed a prospective study that included 27 consecutive patients who were successfully treated with VA-ECMO in a medical ICU between 2016 and 2019 and were prescribed 3-month anticoagulation therapy per protocol after decannulation. Exclusion criteria was dying on ECMO or while on the ICU. Data analysis included demographics, mean days on ECMO, 3-month survival, and thromboembolic and bleeding events (excluding immediate post-decannulation bleeding, since anticoagulation was prescribed 24h after). RESULTS Our cohort consisted mainly of men (N = 21, 78%), with a mean age of 60 ± 11 years and a mean time on VA-ECMO of 8 ± 3 days, who primarily suffered from post-cardiotomy cardiogenic shock (N = 9, 34%) or acute myocardial infarction (N = 6, 23%). 5 patients (18%) received a heart transplant. Regarding anticoagulation, 15 patients (60%) had other indications apart from the protocol, like incidental thrombus diagnosis (N = 7, 26%) or valve surgery (N = 5, 18%). Anticoagulation therapy was not feasible in 1 patient (4%) with severe thrombopenia. No patients had severe or life-threatening bleeding events in the follow-up, although 8 patients (30%) had bleeding events, mainly gastrointestinal bleeding (N = 4, 15%), requiring withdrawal of anticoagulation in 1 patient. The incidence of thromboembolic events was 7%; two patients with low-risk pulmonary embolisms. During the 3-month follow-up survival rate was 95%. CONCLUSIONS This is the only study to date addressing the strategy of 3-month anticoagulation therapy after VAECMO, showing it is feasible and safe and may be helpful in reducing or ameliorate thromboembolic complications in the follow-up, although it is not exempt of complications. Abstract Figure. Kaplan-Meier survival analysis

The effects of propofol on extracorporeal membrane oxygenation oxygenator exchange

2021 ◽  
pp. 039139882110160
Author(s):  
Kelsey L Browder ◽  
Ayesha Ather ◽  
Komal A Pandya
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Cumulative Dose ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Ecmo Support ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Vv Ecmo

The objective of this study was to determine if propofol administration to veno-venous (VV) extracorporeal membrane oxygenation (ECMO) patients was associated with more incidents of oxygenator failure when compared to patients who did not receive propofol. This was a single center, retrospective cohort study. The primary outcome of the study is oxygenator exchanges per ECMO day in patients who received propofol versus those who did not receive propofol. Patients were 18 years or older on VV-ECMO support between January 1, 2015 and January 31, 2018. Patients were excluded if they required ECMO support for less than 48 h or greater than 21 days. There were five patients in the propofol arm that required oxygenator exchanges and seven patients in the control arm. The total number of oxygenator exchanges per ECMO day was not significantly different between groups ( p = 0.50). When comparing those who required an oxygenator exchange and those who did not, there was no difference in the cumulative dose of propofol received per ECMO hour (0.64 mg/kg/h vs 0.96 mg/kg/h; p = 0.16). Propofol use in patients on VV-ECMO does not appear to increase the number of oxygenator exchanges.

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Perfusion ◽  
2021 ◽  
pp. 026765912110128
Author(s):  
Ismael A Salas De Armas ◽  
Bindu Akkanti ◽  
Pratik B Doshi ◽  
Manish Patel ◽  
Sachin Kumar ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Injury Severity ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Trauma Patients ◽  
Membrane Oxygenation ◽  
Trauma Service ◽  
Proper Patient Selection ◽  
Vv Ecmo

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

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